Stammering: Tough talking

Early intervention is important with speech difficulties, and there is a lot that childcarers can do to help children who stammer, as Maggie Jones explains

Stammering, or stuttering, is much more common in young children than people think. Five per cent of pre-school children stammer, which means that, at any one time, 188,000 children aged under five in the UK are affected. For the majority, stammering will be a phase they grow out of, but about a quarter to a third are at risk of developing a stammer in adult life unless they receive speech and language therapy in their early years.

Likely patterns

Stammering commonly begins between the ages of two and five. Nobody knows what causes it. Children and adults vary in the fluency of their speech, from those who chatter away 19 to the dozen, to those who speak slowly with lots of 'ums' and 'ers', so stammering may simply be one end of this spectrum. There is a genetic component, as children of stammerers are more likely to develop a stammer themselves, and also many more boys than girls are affected - 80 per cent of stammerers are male.

Stammering can take several forms. It may consist of repeated sounds (s-s-s-school) or prolonged sounds (ssssschool). Sometimes children stammer over one consonant or syllable. Some have speech that sounds forced, tense or jerky. Others become so blocked that they may tense up their faces and clench their fists while trying to get any sound out at all.

Stammering is not simply a speech difficulty, but a serious communication problem. It can undermine a child's confidence and self-esteem, affect their interaction with others and hamper their education. Children who stammer may become so self-conscious that they try to avoid speaking altogether and avoid situations in which they know they will be expected to speak. Being questioned by an adult can be a torment, and other children may tease the child, ignore them, or exclude them from their games.

Sometimes nursery workers may miss a stammering child because the child is quiet and doesn't engage in conversation. He may be a child who works discreetly in a corner, never asks for anything and never draws attention to himself.

It can be hard for adults to spot when stammering becomes a problem. Many children have some degree of dysfluency when they are learning to talk, repeating words and sounds, and stopping and starting again. This is especially common when a child is excited or agitated. Children may have episodes of dysfluency during the years of rapid language development between two and five years of age, and at other times speak quite normally.

However, if these episodes occur often, it may cause tension and distress in both the speaker and the listener. Adults can put demands on a child to speak fluently, making them self-conscious, especially if they are sensitive to failure. Adults who talk too fast, don't listen to the child and interrupt will make things worse, and some children tune in to their parent's anxiety about speech, which can also make the problem worse.

As it is impossible to know which children will pass through a stage of stammering into fluent speech and which will not, it is important to seek help from a speech and language therapist as soon as possible. The younger the child when treatment is given, the more effective it will be. If a doctor or health visitor will not refer a child, it is possible for the parent to do so directly.

Formal treatments

Early intervention by a speech and language therapist can prevent persistent stammering. Research has shown that the duration of treatment for children is much shorter than for adults, lasting from eight weeks to a year. Treatments for pre-school children are highly effective, usually giving complete remission and little relapse in 95 per cent of those treated.

It is argued that while some of these children would have stopped stammering anyway, the treatment has done them no harm, so it is better to treat unnecessarily than to miss children who would otherwise develop a serious problem. The therapist will involve the parents in the treatment and assessment, and may look at other aspects of the child's communication development, such as the way he or she talks and plays with others, and his general understanding and development of language.

There are two main approaches, sometimes called indirect and direct therapy. The first, Parent-Child Interaction Therapy, aims to help parents to identify factors in the communication styles within the family that help the child to regain more fluency.

A more direct approach is called the Lidcombe Programme, which was pioneered successfully in Australia. Speech therapist Mary Kingston from the Child Development Unit in Norwich went to Australia to see how it worked and is now training other speech therapists in the UK. The method relies on parents spending ten to 15 minutes correcting their child's speech every day. The child is encouraged to talk using books and pictures. Every time the child stammers, the parent asks him to say the word again without the 'bump.' When he does this, he gets a small reward. The therapy seems to work best with children between the ages of three and five.

So, how can you make speaking easier for a child?

• Look at the child and get your face on the same physical level.
• Try not to use very adult language - keep it at a child's level.
• Slow down your rate of talking to enable the child to speak back more slowly.
• Talk about the present and things that can be seen.
• Reduce the number of questions you ask and allow the child plenty of time to answer.
• Allow the child to choose when to tell you things.
• Give the child time, and show that you are interested and listening.
• Never be tempted to complete the child's sentences for him or fill in what you think he is trying to say.
• Praise the child for things he has done well to increase his confidence.
• Rhymes and singing may help a child to achieve fluency - many children do not stammer when they sing.
• Never force a child with a stammer to read aloud in front of others.

Finding time to do entertaining activities with the child that do not require a great deal of speech will help him or her to relax. Spontaneous, easy talking may then emerge.

Specialist help

The Michael Palin Centre for Stammering Children was set up by the Association for Research into Stammering in Childhood, in partnership with Camden and Islington Community Services NHS Trust. It offers speech and language therapy to children from all over the UK and has the greatest concentration of expertise in childhood stammering in the country.